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This year marks the 20th anniversary of the publication by the Institute of Mother and Child in Warsaw of a document establishing the Polish standards for preventive health care of school-age children and adolescents by general practitioners, which are still in force today. Since then, their health status and the health risk factors have changed. Polish society and its expectations of health care are also different. The Polish economy has grown, and the proportion of the public budget spent on health care has increased. The current system of preventive health care for young people seems to be facing a problem. Over the past decade, the percentage of children and adolescents attending preventive medical visits in Poland has decreased by approximately 30%. During well-care visits, doctors commonly avoid selected physical examinations and sensitive topics, such as sexuality or mental health. It appears that most young people visit doctors only because they falsely believe that check-up visits are mandatory and usually rate the experience negatively. The co-authors of this paper conclude that there is a need for a broad debate on the Polish standards of preventive health care for adolescents and their possible reform, which would lead to their adaptation to the challenges of modern times and the opportunities offered by the progress of medical science and technology. The selection of topics is subjective and certainly does not cover all aspects requiring attention. The authors’ intention is to contribute to further discussion rather than to provide a basis for conclusions or postulates. [ABSTRACT FROM AUTHOR]

One of the main goals at the European level is that healthcare systems must be accessible but at the same time cost-effective and sustainable in the long term. The implementation of eHealth is one way to contribute to this goal. The presented paper is focused on the evaluation of the usage of eHealth tools in medical clinics in the Czech Republic. eHealth development is an important tool of health policy in the Czech Republic and an important goal of Czech health care reforms, as it has the potential to improve the availability of healthcare and to increase its quality and effectiveness. The aim of the paper is to evaluate the use of eHealth tools adopted in primary care medical clinics according to the type of provided healthcare and according to the NUTS 3 regions in the Czech Republic. The evaluation is performed by application of the multicriteria decision-making methods. The research results indicate that the usage of eHealth tools in medical clinics vary significantly depending on the type of healthcare provided and also in individual NUTS 3 regions. It was found that the eHealth tools are used to the greatest extent in gynecological clinics and to a lesser extent in dentist clinics. Based on the comparison of the eHealth Index, the ranking of the regions in the Czech Republic was determined from the most successful to the least successful in terms of the use of eHealth tools in medical clinics. [ABSTRACT FROM AUTHOR]

In the medical practice in China, giving and taking "red envelopes" (monetary gifts) is a common phenomenon although few openly admit it. This paper, based on our empirical study including data collected from interviews and questionnaires with medical professionals and patients, attempts to explore why "red envelopes" have become a serious problem in the physician-patient relationship and how the situation can be improved. Previous studies show that scholars tend to correlate the spread of "red envelopes" in health care sector to the commercialization trend, the general erosion of traditional values, and the lowering of the moral level in the medical field. However, in this paper, the authors argue that medical professionals' choice of taking "red envelopes" is actually more a way to compensate for their problematic self-image and marred dignity in real practice. Medical professionals in China as a whole are in an embarrassing situation where the work pressure and income, and the sense of pride that used to be part of their profession are not comparable to each other. Under this circumstance, we believe that the effective way to deal with the "red envelopes" issue does not lie solely in introducing more stringent regulations or granting medical professionals higher payments, but rather in protecting and enhancing the professional dignity of all those working in healthcare. And on top of that, there must also be effort to cultivate a more favorable moral environment. [ABSTRACT FROM AUTHOR]

Objective: Taiwan has launched a Family Practice Integrated Care Project (FPICP) to develop an accountable family doctor system since March 2003. We aim to report the effectiveness of this nationwide demonstration programme over a 10-year period.Methods: Papers and reports related to the FPICP published both in English and in Chinese from 2003 to 2015 were collected systematically based on keywords including 'family doctor', 'primary care', 'integrated care' and 'Taiwan'. Also collected and reviewed were national health insurance administration annual reports and related publications from Taiwan Association of Family Medicine. Quality care indicators including structure, process and outcome for programme monitoring were reported.Results: Up to June 2015, the project had enrolled a total of 10.5% of Taiwan's population. Approximately 24.9% of primary care physicians and 29.7% of community clinics joined the project to serve the members of 426 community health care groups (CHCGs). Compared to non-members, CHCG members received more preventive care services, especially in adult health examination (49% versus 19%), Pap smear (29% versus 22%), elderly influenza vaccination (42% versus 28%) and immunochemical faecal occult blood test (43% versus 31%) (P < 0.01). Members showed a markedly high level of satisfaction (>95%), especially in overall satisfaction, provision of health consultation and information, and improvement in understanding personal health condition.Conclusions: In the future, through the support of family physicians and CHCGs, a person-centred integrated health care delivery system can be an effective solution to the current barriers in the medical care system. [ABSTRACT FROM AUTHOR]

This case study describes the development and implementation of an innovative integrated primary-secondary model of care for people with complex diabetes. The aim of the paper is to present the experiences of clinicians and researchers involved in implementing the 'Beacon' model by providing a discussion of the contextual factors, including lessons learned, challenges and solutions. Beacon-type models of community care for people with chronic disease are well placed to deliver on Australia's health care reform agenda, and this commentary provides rich contextual information relevant to the translation of such models into policy and practice. [ABSTRACT FROM AUTHOR]

Aim To explore the debate on the development of the nurse practitioner profession in the Netherlands. Background In the Netherlands, the positives and negatives of nurse practitioners working in the medical domain have been debated since the role was introduced in 1997. The outcome of the debate is crucial for nurse practitioners' professional development and society's justification of their tasks. Method Review of 14 policy documents, 35 opinion papers from nurses, 363 opinion articles from physicians and 24 Dutch research papers concerning nurse practitioners from 1995 to 2012. Results Two discourses were revealed: one related to efficiency and one to the development of the profession. In both, the nurse practitioner role was presented as a solution for healthcare and workforce problems, while arguments differed. The efficiency discourse seemed most influential. Opinions of nurse practitioners were underrepresented; taking up new responsibilities was driven by the wish to improve patient care. While most physicians were willing to delegate tasks to nurse practitioners, they wished to retain final responsibility for medical care. Limitations All available publications were extensively studied, which could not include unpublished policy documents from the government or influential parties. This may have led to some selectivity. Conclusion The case of the Netherlands shows that nurses in developing their advanced role are facing barriers, similar to those in other countries. The dominance of efficiency arguments combined with protection of medical autonomy undermines the development towards nursing care that really benefits patients. Implications for nursing and health policy Nurse practitioners should strive to obtain positions in which they are allowed to make their own decisions and wise use of healthcare resources for the good of patients and society. Nurse practitioners should aim to become members of influential healthcare Boards in their countries, in which they can raise their voices and be involved in policy making. [ABSTRACT FROM AUTHOR]

Abstract: The health systems of former Soviet Union countries are undergoing reform away from the highly centralised, resource-intensive, specialised and hierarchical Soviet system, towards a more generalist, efficient health service with greater focus on primary health care. Family Health Nursing is a new model designed by WHO Europe in which skilled generalist community nurses deliver primary health care to local communities. This paper presents a qualitative evaluation of the implementation of Family Health Nursing in Tajikistan. Using Stufflebeam''s ‘Context, Input, Process, and Product’ model, the paper aims to evaluate the progress of this reform, and to understand the factors that help or hinder its implementation. A four-phase research design investigates the development of the Family Health Nurse role over time. In 5 rural areas, 6 focus groups and 18 interviews with Family Health Nurses, 4 observations of their practice, 7 interviews with families and 9 interviews with physicians were carried out. Data were analysed according to the components of Stufflebeam''s model. Although the legacy of the Soviet health system did not set a precedent for a nurse who is capable of decision-making and who works in partnership with the physician, Family Health Nurses were successfully implementing new practices. Crucial to their ability to do so were the co-operation of physicians and families. Physicians were impressed by the nurses’ development of knowledge, and families were impressed that the nurses could offer real solutions to their problems. However, failure to pay the nurses regular salaries had led to serious attrition of the workforce. We conclude that the success of the Family Health Nurse role in other countries will depend upon its position in relation to the historical health care system. [Copyright &y& Elsevier]

The aim of this systematic review was to assess evidence of the impact of commissioning on health service use, quality, outcomes and value for money and to consider findings in the Australian context. Systematic searches of the literature identified 444 papers and, after exclusions, 36 were subject to full review. The commissioning cycle (planning, contracting, monitoring) formed a framework for analysis and impacts were assessed at individual, subpopulation and population levels. Little evidence of the effectiveness of commissioning at any level was available and observed impacts were highly context-dependent. There was insufficient evidence to identify a preferred model. Lack of skills and capacity were cited as major barriers to the implementation of commissioning. Successful commissioning requires a clear policy framework of national and regional priorities that define agreed targets for commissioning agencies. Engagement of consumers and providers, especially physicians, was considered to be critically important but is time consuming and has proven difficult to sustain. Adequate information on the cost, volume and quality of healthcare services is critically important for setting priorities, and for contracting and monitoring performance. Lack of information resulted in serious problems. High-quality nationally standardised performance measures and data requirements need to be built into contracts and ongoing monitoring and evaluation. In Australia, there is significant work to be done in areas of policy and governance, funding systems and incentives, patient enrolment or registration, information systems, individual and organisational capacity, community engagement and experience in commissioning. [ABSTRACT FROM AUTHOR]

This paper examines the feasibility of achieving U.S. health care reform and prognosis for success. In order to accomplish the task, this paper provides a check list of major problems which emerge continually in the field. In compiling a list of major problems, a tentative list of eight are presented. These problems include the following: unnecessary administrative costs; other major industrial countries can provide adequate health care at a lower rate of the national budget than does the U.S.; increase in malpractice insurance; shortage of primary care physicians in the rural and inner city areas; failure of health insurance; abundance of technology; distribution of care; and increase in health care costs. According to the author, these eight major problems give some indication to the complexity of the issues involved in the health care reform. These problems should be viewed in the context of the five major participant groups in health care: consumers, politicians, physicians and other health care providers, employers, and insurance companies. This paper briefly discusses the affected participants. It also provides a brief review of the proposed solutions to the problem of health care reform.

Progressive evaluations by the Organization for Economic Co-operation and Development ( OECD) demonstrate that health care is now or becoming unaffordable. This means nations must change the way they manage health care. The costly nature of health care in most nations, as a percentage of Gross Domestic Product ( GDP) seems independent of the national funding models. Increasing evidence is demonstrating that the lack of involvement by clinicians (doctors, nurses, pharmacists, ancillary care and patients) in e-health projects is a major factor for the costly failures of many of these projects. The essential change in focus required to improve healthcare delivery using e-health technologies has to be on clinical care. To achieve this change clinicians must be involved at all stages of e-health implementations. From a clinicians perspective medicine is not a business. Our business is clinical medicine and e-health must be focussed on clinical decision making. This paper views the roles of physicians in e-health structural reforms. [ABSTRACT FROM AUTHOR]

This paper uses the controversy over the denial of care on futility grounds as a window into the broader issue of the role of cost in decisions about treatment near the end of life. The focus is on a topic that has not received the attention it deserves: the difference between refusing medical treatment and demanding it. The author discusses health care reform and the ethics of cost control, arguing that we cannot achieve universal access to quality care at affordable care without better public understanding of the moral legitimacy of taking cost into account in health care decisions, even decisions at the end of life. [ABSTRACT FROM AUTHOR]

Abstract: This paper aims to estimate the pattern of physician visits and hospitalisation by socioeconomic position in Great Britain and Spain before and after important changes in their health systems during the 1990s. These changes have been accompanied by a trend toward pro-rich inequality in physician use, especially in outpatient consultation in Great Britain, whereas the pro-poor inequality in GP consultation and the pro-rich inequality in specialist consultation in Spain before the changes have been maintained. Although the pro-rich inequality in hospitalisation observed in both countries before their health system changes continues to be seen, the differences have been reduced, suggesting a trend toward socioeconomic equality in hospitalisation. In any case, with the exception of visits to GP in Spain, in both countries greater use of health services by professionals and managers is observed than for the rest of the population. [Copyright &y& Elsevier]

The United States faces tremendous challenges with its healthcare system. By any standard, it is expensive and performs poorly in most measures of health and thus, is in great need of reform. But how do we reform things without making the situation worse? Some of the more fundamental problems arise from the combination of a fee-for-service payment system for physicians with insurance-based financing care. This combination results in conflicts among the interests of patients, physicians and payers. This paper examines this issue from a decision analytic perspective, starting with a definition of the patient-centered view, and an assessment of the practicality of controlling costs by making healthcare more patient-centric. It then illustrates how fee-for-service models corrupt decision-making and other solutions designed to reign in the abuses of the fee-for-service model and also negatively impacts the quality of decision making for individual patients. Whatever the strategies for health reform, the degree of patient-centeredness of care is a benchmark that allows policy makers to understand how far they have had to deviate from optimal to achieve the desired ends of cost control. [ABSTRACT FROM AUTHOR]

Disruptive innovation has brought affordability and convenience to customers in a variety of industries. However, health care remains expensive and inaccessible to many because of the lack of business-model innovation. This paper explains the theory of disruptive innovation and describes how disruptive technologies must be matched with innovative business models. The authors present a framework for categorizing and developing business models in health care, followed by a discussion of some of the reasons why disruptive innovation in health care delivery has been slow. [ABSTRACT FROM AUTHOR]

This paper examines the relative importance of various independent variables for predicting five separate measures of physician utilization in a rural community. The independent variables include socioeconomic, demographic, attitudinal, and health status factors. The results are comparable to those of national studies which find that health status is the primary determinant of utilization. Income, price measures, and travel time are notable for their relative unimportance in this rural area. This suggests that resources are more likely to be allocated on the basis of medical need within a given health care market than across a number of market areas. [ABSTRACT FROM AUTHOR]